Master the board step 3

Master the Boards: USMLE Step 3
Meniere’s Disease
Same presentation as labyrinthitis (vertigo, hearing loss, tinnitus), but Meniere’s
is chronic with remitting and relapsing episodes. Treat with salt restriction and
diuretics. For severe disease, ablation of 8th cranial nerve on one side may be
needed.
Acoustic Neuroma
This is an 8th cranial nerve tumor that can be related to neurofibromatosis, or
Von Recklinghausen’s disease. Acoustic neuroma presents with ataxia in addition
to hearing loss, tinnitus, and vertigo.
Diagnostic Testing
··
MRI of the internal auditory canal.
Treatment
··
Treat with surgical resection.
Perilymph Fistula
Head trauma or any form of barotrauma to the ear may rupture the tympanic
membrane and lead to a perilymph fistula. Fix the hole surgically.
Wernicke-Korsakoff Syndrome
Wernicke-Korsakoff syndrome presents as follows:
··
History of chronic heavy alcohol use
··
Confusion with confabulation
··
Ataxia
··
Memory loss
··
Gaze palsy/ophthalmoplegia
··
Nystagmus
Diagnostic Testing
With memory loss, it is very important to perform the following tests:
··
Head CT
··
B12 level
··
Thyroid function (T4/TSH)
··
RPR or VDRL
Treatment
··
Treat with thiamine. Acutely, give IV dose; then may switch to oral.
··
Also give glucose with thiamine, but administer thiamine first, then glucose.
236